levamlodipine

General

Pronunciation:
lev-am-loe-di-peen


Trade Name(s)

  • Conjupri

Ther. Class.

antihypertensives

Pharm. Class.

calcium channel blockers

Indications

Hypertension (as monotherapy or in combination with other antihypertensives).

Action

Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting primarily in peripheral arterial vasodilation.

Therapeutic Effect(s):

Reduction in blood pressure.

Pharmacokinetics

Absorption: Well absorbed after oral administration (64–90%).

Distribution: Unknown.

Protein Binding: 93%.

Metabolism and Excretion: Mostly metabolized by the liver; primarily excreted in urine (10% as unchanged drug).

Half-life: 30–50 hr.

TIME/ACTION PROFILE (plasma concentrations)

ROUTEONSETPEAKDURATION
POunknown6–12 hrunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity.

Use Cautiously in:

  • Aortic stenosis;
  • Severe obstructive coronary artery disease (↑ risk of worsening angina or MI)
  • Severe hepatic impairment
  • OB:   Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
  •  Lactation:  Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
  • Pedi:   Children <6 yr (safety and effectiveness not established);
  • Geri:  ↑ risk of hypotension in older adults (dose ↓ recommended) .

Adverse Reactions/Side Effects

CNS: dizziness, drowsiness

CV: peripheral edema, palpitations

Derm: flushing

GI: abdominal pain, nausea

Misc: fatigue

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Route/Dosage

PO (Adults): 2.5–5 mg once daily.

PO (Adults >65 yr): Initiate at 1.25 mg once daily, ↑ as required/tolerated (up to 5 mg/day).

PO (Children ≥6 yr): 1.25–2.5 mg once daily.

Hepatic Impairment 
PO (Adults): Initiate at 1.25 mg once daily, ↑ as required/tolerated (up to 5 mg/day).

Availability

Tablets: 2.5 mg, 5 mg

Assessment

  • Monitor BP and pulse before therapy, during dose titration, and periodically during therapy. Titration usually occurs after 7–14 days.
  • Monitor frequency of prescription refills to determine adherence.

Lab Test Considerations:

Total serum calcium concentrations are not affected by calcium channel blockers.

Implementation

  • Administer once daily.

Patient/Family Teaching

  • Instruct patient to take medication as directed, even if feeling well. Advise patient to read  Patient Information  before starting therapy and with each Rx refill in case of changes.
  • May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to the medication is known.
  • Encourage patient to comply with other interventions for hypertension (weight reduction, low-sodium diet, smoking cessation, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
  • Instruct patient and family in proper technique for monitoring BP. Advise patient to take BP weekly and to report significant changes to health care professional.
  • Advise patient to notify health care professional if irregular heartbeats, dyspnea, swelling of hands and feet, pronounced dizziness, nausea, feeling faint or lightheaded occurs.
  • Advise patient to notify health care professional immediately if worsening chest pain or heart attack occurs.
  • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken, to avoid alcohol, and to consult health care professional before taking any new medications, especially cold preparations and NSAIDs.
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Decrease in BP.

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